Therapeutics - Urinary Incontinence 1

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  1. What are the 5 types of Urinary incontinence?
    • Stress
    • Urge
    • Overflow
    • Mixed
    • Functional
  2. What is Urgency incontinence?
    Detrusor muscle over activity
  3. What is Stress incontinence?
    Increased pressure and impaired urethral sphincter
  4. What volume of urine loss is characteristic of stress urinary incontinence?
  5. What volume of urine loss is characteristic of urgency urinary incontinence?
  6. What are the main risk factors for Stress urinary incontinence?
    • Women: pregnancy, childbirth, menopause, cognitive impairment, obesity and age
    • Men: lower urinary tract surgery, neurologic impairment
  7. What are the risk factors of urgency urinary incontinence?
    Age, neurologic diseases, bladder outlet obstruction (like BPH)
  8. What are the symptoms of Obstruction incontinence?
    Dribbling and frequent small volume urination
  9. What is the most common type of urinary incontinence?
  10. What drugs classes can cause UI?
    • Alpha-adrenergic agonists (Men)
    • Alpha-adrenergic antagonists (Women)
    • ACE inhibitors
    • Anticholinergics: Antiarrhythmics, Antidiarrheals, Antihistamines, Antiparkinson agents, antispasmodics, Antiphyscholtics
    • CCBs
    • GABA agents
    • Loops
    • Opioids
    • NSAIDs
    • Sedative hypnotics
    • Thiazolidinediones
    • TCAs
  11. What disease states can cause UI?
    • Delirium (drugs, acute illness)
    • Infection/Inflammation/Immobility
    • Atrophic Vaginitis
    • Pharmacologic
    • Psychological
    • Endocrine (Diabetes, Calcium)
    • Restricted Mobility/Retention
    • Stool Impaction
    • DRIP:
    • Delirium (drugs, acute illness)
    • Retention (hypocontractility or outflow obstruction)
    • Impacted stool/Inflammation/Infection
    • Polyuria (drugs, high output states)
  12. What drugs aggravate Stress UI?
    Alpha blockers
  13. What is the first line therapy for Stress UI?
    • Non-pharmacologic:
    • Kegels and Bladder training
  14. What are the pharmacologic therapies for Stress UI?
    • Duloxetine
    • Alpha agonists
    • Topical estrogens
  15. What is the drug of choice of stress UI?
    Duloxetine when tolerated
  16. What is the MOA of Duloxetine?
    Serotonin and norepinephrine reuptake inhibitor
  17. What enzymes is Duloxetine metabolized by?
    2D6 and 1A2
  18. What are the negative aspects of Duloxetine (Cymbalta)?
    • High rate of discontinuation due to AE
    • N/V/D
    • HA
    • Insomnia
    • Constipation
    • Fatigue
    • Somnolence
  19. How must you discontinue Duloxetine (Cymbalta)?
    Taper after long term use
  20. What drugs are available to treat Stress UI?
    • Duloxetine (Cymbalta)
    • Alpha adrenergic receptor AGOnists (Phenylephrine and pseudoephrine)
    • Estrogens
  21. Why are Phenylephrine and pseudoephrine (alpha adrenergic agonists) not first line for stress UI?
    CI in HTN, Arrhythmias, CAD, MI, hyperthyroidism, renal failure, narrow-angle glaucoma
  22. When would you use Estrogens for Stress UI?
    When Urethritis or vaginitis are also present due to estrogen deficiency
  23. What patients should not use Systemic Estrogens for Stress UI?
    Hx of breast cancer
  24. What route of administration is preferred for estrogens for stress UI?
  25. What is the MOA of estrogens in stress UI?
    Enhances sensitivity of alpha receptors
  26. What is the first line therapy for Urge UI?
    • Non-pharmacologic:
    • Biofeedback
    • Kegels
    • Bladder training
  27. What pharmacologic treatments (drug classes) are available for urge UI?
    • Anticholinergics/antispasmodics
    • Beta 3 agonist
    • Botulinum toxin
  28. What is the gold standard for urge UI?
    Oxybutynin (anticholinergic/antispasmodic)
  29. What are the dosage forms for Oxybutynin (Ditropan)?
    • IR
    • XL
    • Topical gel
    • Transdermal patch
  30. Which dosage form of Oxybutynin (Ditropan) is best tolerated, why and what is its downfall?
    • XL – requires no dose adjustment
    • Downfall = no effects for 4 weeks
  31. What are the adverse effects of Oxybutynin (Ditropan)?
    • Antimuscarinic
    • Orthostatic hypotension
    • Weight gain
  32. What is the major benefit of Oxybutynin in treatment of Urge UI?
    No significant DDIs
  33. What OTC medication is available for Urge UI?
    Oxytrol patch
Card Set:
Therapeutics - Urinary Incontinence 1
2014-08-27 16:50:44
Therapeutics Urinary Incontinence
Therapeutics - Urinary Incontinence
Therapeutics - Urinary Incontinence
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